The importance of canine rehabilitative exercise (use it or lose it)

Another subject i've been meaning to post about for a while, involving a really special client (they are all special, but I have a real affinity for German Shepherds). Lunas' owner got in contact over a year ago and asked for some assistance, as she did not feel that, despite the best efforts of vets and specialists Luna was making any real progress after a really serious operation, so much so that she was facing two further surgeries. Luna had previously suffered from an intervertebral disk injury in her lumbar spine, and had been operated on with a proceedure called a laminectomy and partial disectomy which you can find out more about here. As you can see from the picture below the operation was really invasive, and Luna had a huge amount of work to do to recover.

Before we get into the nitty gritty though, its important to understand some of the history prior to Lunas' owner contacting me.

Way back in 2019 when Luna was 3 and a half years old she was seen by a consultant at Southfields Veterinary Specialists, as her owner had noticed some gait abnormalities and intermittent lameness. Because of her age however the owners sensibly chose a conservative approach, even enrolling themselves on an accredited canine and equine massage course to try and support her. However, over the next 12 months (and certainly not helped by the covid situation) Lunas' gait continued to deteroriate and she found herself in front of the specialist once again. MRI's revealed a protusion of the intervertebal disc at L7/S1, which is effectively where the spine meets the pelvis (also known as the lumbosacral joint). More worryingly, this was causing a compression of the spinal cord, which can have very serious consequences if left untreated. You can see a video of her before her surgery below (apologies from the owners re the camera work!)

It was at this point that the owners elected to allow Luna to undergo surgery. A laminectomy involves cutting a hole in the vetrebra to remove pressure on the spinal cord, whereas a discetomy removes any damaged area of disc, so as you can imagine this kind of surgery comes with a great deal of risk, so is never an easy decision. Thankfully the surgery was succesful, and recovery involved 6 weeks of crate rest and multiple follow-ups. This is however by no means the end of the story (and actually gets us to the point of the blog post)

Just over a year ago, and nearly 12 months after her operation Lunas' owner contacted me for some veterinary physiotherapy advice. Albeit Luna had recovered from the surgery, the vets had taken a very conservative approach to her rehabilitation, limiting exercise and sadly not suggesting physiotherapy as a modality to give her the best chance of recovery (Its a constant issue in our profession). Luna was understandably starting to get somewhat frustrated with the restrictions, her gait wasnt improving, and she wassnt making any real progress. Partly down to the limitations in exercise Luna got somewhat over-excited one day whilst meeting another dog, and shortly after became bilaterally lame on her hind limbs. Further vets appointments ensued, with more specialist appointments, the net result being Luna was due to have cruciate surgery on her right leg in July 2021, with the left operated on 6 weeks later, which is around the time the owners contacted us for advice.

Image courtesy of PDSA

When I first met Luna it was obvious that she had some gait issues, and she certainly hadn't benefiited from being on restricted exercise, but, more importantly I felt there was a lot that could be done from a physiotherapy perspective to be able to avoid the surgery altogether. Albeit there were some potential issues regarding the cruciate ligaments, what Luna really lacked was the muscle mass needed to support herself properly. She was also suffering from adaptive shortening of her tendons (because she simply wasn't using her back legs properly) and had a lot of pain from compensating for her poor gait for a prolonged period of time. After my initial assesment the owner and I had a lengthy discussion regards exercise, canine massage, stretching and some really simple pain management techniques such as using ice-packs or heat packs to reduce inflammation or increase blood flow. Over the course of the following months we gradully increased the amount of lead walking time Luna was allowed, and once we were happy that she could cope we re-introduced off lead walking for short periods, which gradully became longer. The owners diligently took Luna through a range of stretching exercises to gradully increase tendon length, and we also introduced cavaletti poles (see below) to assist in naturally increasing the range of motion in her hind limbs. We also realised that there was some arthritic changes in her right hock, again down to the increased weight bearing on one side from compensating for her disc pain, so we put a regular programme of low level laser therapy in place to ensure it didnt get any worse (once a dog, horse or human has arthritis it never goes away, so all we can do is limit its progression)

When we were absolutely certain that Luna was fit and strong enough we also reintroduced hydrotherapy into the therapeutic mix, first on a treadmill, and then in the pool. She had previously been to hydrotehrapy after her operation, but the benefits had plateaued due to the restricted exercise.

So what has been the end result of all of the owners hard work? Well see for yourself in the video below...

As you can see, not only is Luna fit, healthy and loving life, she is now as active, carefree and pain free as a dog can be expected to be. Bear in mind she NEVER HAD THE CRUCIATE SURGERY. She never went under general anaesthetic (twice), or endured weeks of pain and crate rest. She also didnt need antibiotics or learn how to walk properly again.

Now dont get me wrong - the vet and the specialist made the right call based on what they saw, but hopefully you can also see that surgery doesnt have to be the only solution. Similarly, Lunas' recovery is down to a team of people, including most importantly the owners who had the patience and dedication to do what was neccesary. What's most important however is to understand that the body, whether dog, horse, human or otherwise, has an incredibly efficient "use it or lose it" system. This means that if you are not putting joints and limbs through a range of motion that they can cope with, the body will start to adapt, to a point where the joints motion becomes restricted - you didnt use it, so you are going to lose it - the body doesnt think you need it any more. Think about how quickly we lose fitness if we stop jogging/running/walking. Or how we lose muscle mass and strength if we stop going to the gym, or go from a physical job to a sedentary one. Our animals are just the same - we are made from the exactly the same materials. So if a dog is on restricted exercise its body will adapt, shortening tendons that havent been stretched, and reducing muscles that are no longer needed. Ligaments lose some of their strength which is needed to stabilise joints. Even physical awareness changes (known as proprioception) so they are less able to cope with uneven terrain or obstacles, so are more likely to trip or fall. In Lunas' case this was exactly what was happening, she was losing muscle and tendon strength, which was having the knock-on effect of putting too much stress through her stifle joints, putting pressure on weakened cruciate ligaments. Once this was identified we put a very gradual, progressive plan in place to build her back up, increasing the range of motion in the joints, strengthening the muscles and improving her proprioception. I like to call it "active recovery", enabling a dog to not only recover when things go wrong, but to thrive, and ideally be stronger, fitter and more active than ever before.

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